beta-Blockade in noncardiac surgery: outcome at all levels of cardiac risk.
OBJECTIVE
We hypothesized that the relationship among beta-blocker use, heart rate control, and perioperative cardiovascular outcome would be similar in patients at all levels of cardiac risk.


METHODS
Retrospective cohort study.


METHODS
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.


METHODS
Among all patients who underwent various noncardiac surgical procedures in 2000, those who received perioperative beta-blockers were matched and compared with a control group from the same patient population.


METHODS
Thirty-day stroke, cardiac arrest, myocardial infarction, and mortality, as well as mortality at 1 year.


RESULTS
Patients at all levels of cardiac risk who received beta-blockers had lower preoperative and intraoperative heart rates. The beta-blocker group had higher rates of 30-day myocardial infarction (2.94% vs 0.74%, P =.03) and 30-day mortality (2.52% vs 0.25%, P =.007) compared with the control group. In the beta-blocker group, patients who died perioperatively had significantly higher preoperative heart rate (86 vs 70 beats/min, P =.03). None of the deaths occurred among the patients at high cardiac risk.


CONCLUSIONS
Among patients at all levels of cardiac risk undergoing noncardiac surgery, administration of beta-blockers should achieve adequate heart rate control and should be carefully monitored in patients who are not at high cardiac risk.
Kaafarani
Haytham M A
HM
Department of Surgery, Veterans Affairs Boston Healthcare System (112), 1400 VFW Pkwy, West Roxbury, MA 02132, USA.
Atluri
Prasad V
PV
Thornby
John
J
Itani
Kamal M F
KM
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D013514:Surgical Procedures, Operative / Q000379:methods / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists